Using an External Review to Promote Transparency of an Alternative Program for Chemical Dependency

Boards of nursing (BONs) are responsible for regulating the practice of nursing to ensure public health, safety, and welfare and are accountable to the public for proper governance. An independent external review of core structures and processes is a highly recommended means of assessing the degree to which a BON carries out its responsibilities and duties. This article describes the process used by the North Carolina BON to enhance the evidence-based regulatory foundation and transparency of its alternative program for chemical dependency. The effort began with a 2009 review of the program architecture by the Citizen Advocacy Center (CAC). While the BON considered the recommendations from this initial review, the CAC returned in 2010 to review the program's operations. A staff work group used both sets of recommendations to develop a plan. Priorities included implementation of a progressive action policy to enhance program compliance, a quality review of addictionologists' evaluations, an examination of the evidence-based practice foundation of the license reinstatement process, and an internal audit to assess quality improvements. As a result, the regulatory foundation of the BON's policies and procedures is more transparent, understandable, and grounded in evidence-based practice.